The nonpartisan Congressional Budget Office is out this week with a study saying that last month’s Supreme Court decision upholding most of the Affordable Care Act — but allowing states to opt out of Medicaid expansion — would save the government some money.
But the savings would come at a price — 6 million fewer people would gain insurance coverage under Medicaid, the federal-state program that covers certain low-income Americans. The CBO estimates that 3 million of these people — most of them adults — would be able to buy subsidized insurance through state insurance exchanges created by the ACA. That leaves a net 3 million fewer people who will be covered than the 33 million envisioned in the new law.
The good news is that it will save the government $84 billion over 10 years. The bad news is that the cost of whatever health care these 3 million get, usually in hospital emergency rooms, will continue to be shifted onto those with private insurance in the form of higher premiums.
Even worse news: According to estimates in a study published online Wednesday by The New England Journal of Medicine, for each 500,000 adults who fail to gain access to Medicaid, 2,840 more deaths can be expected each year.
Thus, eliminating access to Medicaid for 3 million adults can be expected to contribute to 17,000 premature deaths each year — roughly equal to the fatalities from six 9/11-style terrorist attacks or 2.6 times the number of U.S. military deaths in Iraq and Afghanistan since 2001. Every year.
This is the part about the opposition to the Affordable Care Act that has been so hard to understand: How do you ignore the human cost of leaving 53 million Americans uninsured?
Yes, the Affordable Care Act will be expensive — the CBO estimates the cost at $1.7 trillion over a decade, but it said that the new revenue from taxes, penalties, fees and changes to the Medicare Advantage program will more than offset the cost. Indeed, the CBO estimated that the ACA actually would reduce future budget deficits.
On the other hand, repealing the ACA — as the Republican-led House has voted time and again to do — actually would add $109 billion to the long-term deficit, the CBO said.
The CBO and the Harvard School of Public Health researchers who did the study in The New England Journal were dealing with statistics. They are best guesses by impartial experts. The real savings must be measured by people who don’t die and people who don’t get sick. Human beings.
To quote that eminent expert on mass deaths, Josef Stalin, “When one man dies it is a tragedy, when thousands die it’s statistics.”
When politicians come before you this fall denouncing “Obamacare,” when Republican-dominated state legislatures — including Missouri’s — begin opting out of expanding Medicaid, this is what to ask:
So you’re OK with people suffering needlessly? And you’re OK with killing 17,000 people a year? Because if you are, admit it. Don’t hide behind “we can’t afford it.”
Sure, that’s a viable position. Darwinian, but viable. “Decrease the surplus population” is Scrooge-like, but viable. If you’d rather not raise taxes on the fortunate and on health care freeloaders, that’s a viable position. If you want to continue to allow people to be sick and to die needlessly, that’s a viable position.
But tell us face-to-face. Tell us they have to die because you just flat don’t care.
